Doctors, Health Experts call for integrating comprehensive Maternal, Infant and Young Child Nutrition education into CBME curriculum

New Delhi: Stressing on need to incorporate nutrition competencies in medical education, public health experts, government representatives, doctors and dieticians have called for reforming the medical college curriculum, with a specific focus on Maternal, Infant and Young Child Nutrition (MIYCN) in the country.

Specifically, the medical curriculum needs to be reformed further to incorporate nutrition competencies like breast feeding, complementary feeding in the new Competency Based Medical Education (CBME) of the National Medical Commission (NMC), Dr Kapil Yadav, Professor at the Centre of Community Medicine at the AIIMS and Governing Council member of the Indian Association of Preventive and Social Medicine (IAPSM), said.

The nutritional condition of a woman serves as a strong indicator of the well-being of both herself and her children, Yadav said.

"Unfortunately, many women and children worldwide face triple threats of undernutrition, micronutrient deficiencies and being overweight. This leads to a reduced work capacity, poor well-being and increased risk for infections," he said.

Considering the pressing issue of malnutrition, it is imperative to address the county-level challenges, as India is a vast country and the challenges differ in each state and region, the experts said at a roundtable discussion on MIYCN organised by the IAPSM and All India Institute of Medical Sciences (AIIMS), New Delhi, in association with the UNICEF, on Wednesday.

Dr Zoya Ali Rizvi, Deputy Commissioner, In-charge, Nutrition at the Union health ministry, emphasised the importance of enhancing communication skills in healthcare providers, utilisation of allotted budgets to the programmes, the government's initiatives in strengthening MIYCN and development of targeted training materials for beneficiaries.

Furthermore, she elaborated on the importance of a "well-nourished child developing into a well-nourished adult", contributing towards the country's economic growth.

The burden of anaemia is also very high with 67 per cent children aged below five years and 57 per cent women in the reproductive age group (15-49 years) being anaemic, according to the National Family Health Survey-5 (NFHS-5).

According to the survey (2019-21), the current burden of malnourishment in children under five years in India (stunting, wasting and underweight) is 35.5 per cent for stunting, 19.3 per cent for wasting and 32.1 per cent for underweight.

Malnutrition among women aged 15-49 years is also high at 18.7 per cent. There has been some reduction in recent years as compared to the NFHS-4 of 2015-16, Yadav said.

The members acknowledged the multifaceted nature of MIYCN and committed to integrating comprehensive MIYCN education into the curricula of medical colleges.

This will encompass a spectrum of medical disciplines, including community medicine, paediatrics, obstetrics and gynaecology, medicine, geriatrics and others.

"Our goal is to equip future healthcare professionals with the knowledge and skills necessary to address MIYCN challenges from a multidisciplinary perspective," Yadav said.

"We will invest in faculty development programmes to ensure that educators possess the expertise required to effectively teach MIYCN topics. Continuous professional development will be encouraged, ensuring that the faculty members remain up-to-date with the latest developments in MIYCN," he added.

The experts acknowledged that healthcare disparities exist, with rural communities and the urban poor often facing limited access to essential services, including proper nutrition and maternal and child healthcare.

"By integrating rural and urban field experiences into the MIYCN curriculum, we commit to addressing these disparities and ensuring equitable access to healthcare and nutrition services.

"We recognise that providing healthcare professionals with a comprehensive education that includes practical experiences in rural and urban-poor settings is essential. Such experiences expose students to the realities of healthcare delivery in resource-constrained environments, promoting a more holistic understanding of MIYCN," Dr A M Kadri, President, IAPSM, said.

Medical Dialogues had earlier reported that the NMC released the final Competency-Based Medical Education Regulations 2023. 

The final CBME curriculum for the MBBS course includes objectives of the Indian Graduate Medical Training Programme, National Goals in respect of the Indian Medical Graduates, Institutional Goals, Goals for the Learner, Competency Based Training Programme of the Indian Medical Graduate, Lifelong learner committed to continuous improvement of skills and knowledge.

Apart from these, the Curriculum at length has discussed about the competencies, broad subject specific objectives, skills, integration in respect of 1st professional year subjects including Anatomy, Physiology, Biochemistry, 2nd professional year subjects including Pathology, Microbiology, Pharmacology, 3rd professional year subjects such as Forensic Medicine and Toxicology, Community Medicine, Oto-rhinolaryngology (ENT), Ophthalmology, 3rd professional year part II subjects including General Medicine, Pediatrics, Dermatology, Psychiatry, General Surgery, Obstetrics and Gynaecology, Orthopedics (including Trauma), Anaesthesiology, and Radiodiagnosis.

Further, the final CBME Curriculum has also discussed the phase-wise training and time distribution for professional development. It includes training period and time distribution, the distribution of 4.5 years period, phase-wise distribution of teaching hours. It also discussed the new teaching/learning elements including the foundation course, early clinical exposure, electives, Professional Development including Attitude, Ethics and Communication Module (AETCOM), Learner-doctor method of clinical training (Clinical Clerkship), Assessment etc.

The duration of 4.5 years of the MBBS course has been divided into three phases. The tenure of Phase I or the First Professional phase is 12 months including a Foundation Course of one week and university exams. Similarly, the 12 months long Phase II or Second Professional phase includes university examinations. In the case of Phase III, the tenure is 30 months long and it is divided in Third Professional Part I and Part II. Among these, Third Professional Part I is 12 months long and it includes university exams. In the case of Third Professional Part II, it is 18 months long including the University exams.

Regarding the Assessment and eligibility to appear for Professional examinations, the new CBME curriculum discussed attendance, internal assessment, university examinations, appointment of examiners etc.

The regulations also include AETCOM competencies for first, second and third-year (part I and part II) MBBS. Tables specifying time distribution of MBBS programme & examination schedule, distribution of subjects in each Professional Phase, Foundation Course, Distribution of subject-wise teaching hours of MBBS 1st, 2nd and final year MBBS, clinical posting schedules in weeks, learner-doctor programme, marks distribution for various subjects for University annual examinations, etc. It also includes subject-wise formats for marking the students in theory and practical examinations.

The new regulations also include the curriculum for the Family Adoption Programme. The curriculum discussed in detail about targets to be achieved by the MBBS students in their first, second, and third professional year of the course. Further, the curriculum lists down the competencies that the students should be able to acquire, objectives, suggested teaching-learning methods, suggested assessment methods, and teaching hours.

Further, the Family Adoption Programme curriculum also includes the log book for Family Adoption, which shall include the name of the college, university, address details, name of the students, roll number, village name, Tehsil/District, State/Union Territory, name of the mentor, status of the mentor, name and address and experience of Asha worker, etc.